The preoperative diagnosis of biliary neoplasms is associated with a low sensitivity. To overcome this limitation, probe-based confocal laser endomicroscopy was further developed to enable in vivo microscopic imaging, with confocal miniprobes further miniaturized to such an extent to enable their use even via the instrumentation channel of cholangioscopes. The current data available suggest that this new technology represents a promising approach for further differentiation of strictures and stenosis in the biliary, and perhaps also pancreatic system. Nevertheless, those results are based on a limited number of patients; further studies involving more patients examined at various centers are necessary and already under way to prove the true clinical importance of this new imaging modality.